| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
14,054 |
2,016 |
$338K |
| D1110 |
Prophylaxis - adult |
5,671 |
5,625 |
$197K |
| D0274 |
Bitewings - four radiographic images |
7,047 |
6,980 |
$190K |
| D0120 |
Periodic oral evaluation - established patient |
6,280 |
6,224 |
$138K |
| D1120 |
Prophylaxis - child |
3,102 |
3,077 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,948 |
3,913 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,189 |
6,858 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,177 |
704 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,724 |
3,698 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
7,907 |
7,772 |
$61K |
| D7140 |
Extraction, erupted tooth or exposed root |
867 |
371 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
935 |
537 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
877 |
845 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
452 |
265 |
$30K |
| D2332 |
|
343 |
185 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
482 |
473 |
$19K |
| D0272 |
Bitewings - two radiographic images |
635 |
630 |
$10K |
| D1206 |
Topical application of fluoride varnish |
562 |
551 |
$10K |
| D2330 |
|
150 |
84 |
$7K |
| D2331 |
|
102 |
75 |
$6K |
| D2335 |
|
63 |
38 |
$4K |
| D1999 |
|
1,598 |
1,488 |
$401.00 |